Department of Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, 700025, India.
J Med Case Rep. 2021 Mar 17;15(1):139. doi: 10.1186/s13256-021-02693-w.
Neurocysticercosis is the most common parasitic infection of the central nervous system, brain being the most frequent site. Intramedullary location of cysticercus is a rarely described entity in literature. Widespread dissemination of cysticercus is also considered a rare occurrence, and only a handful of cases are documented, almost exclusively from tropical nations. Here we present a case of disseminated cysticercosis with rare initial presentation as acute dorsal myelopathy resulting from intramedullary cysticercus.
A 62-year-old male patient from India (Asian) presented with features of dorsal myelopathy as manifested by acute-onset symmetric paraparesis, sensory loss below umbilicus, and double sphincter dysfunction. General physical examination revealed pea-sized nodules in skin and tongue. On spinal cord imaging, it was found that he had intramedullary cysticercus with diffuse perilesional edema. Brain and muscle imaging showed extensive cysticercosis suggestive of dissemination. Histological examination from skin nodule and antibody assay confirmed the diagnosis of cysticercosis. Following steroid administration, our patient showed improvement with observable increase in power of the lower limbs. He was subsequently discharged with antiepileptics, symptomatic therapy, and regular physiotherapy. Antihelminthic agents were initially avoided in view of extensive cysticercosis in brain including crucial areas such as brainstem.
Rare manifestation of a rare but treatable disorder makes it an important reportable observation in the context of tropical medicine.
神经囊虫病是中枢神经系统最常见的寄生虫感染，大脑是最常见的感染部位。脑髓内囊虫的位置在文献中很少被描述。囊虫广泛播散也被认为是罕见的情况，只有少数病例有记录，几乎全部来自热带国家。本文报告了一例罕见的播散性囊虫病，其初始表现为罕见的急性脊髓背侧病变，由脑髓内囊虫引起。
一名来自印度（亚洲）的 62 岁男性患者出现了脊髓背侧病变的特征，表现为急性对称性截瘫、脐以下感觉丧失和双括约肌功能障碍。一般体格检查发现皮肤和舌头上有豌豆大小的结节。脊髓成像显示有脑髓内囊虫，伴有弥漫性病变周围水肿。脑和肌肉成像显示广泛的囊虫病提示播散。皮肤结节的组织学检查和抗体检测证实了囊虫病的诊断。在给予类固醇治疗后，患者下肢肌力可见改善，症状有所好转。随后他出院，接受抗癫痫药物、对症治疗和定期物理治疗。鉴于脑内广泛的囊虫病，包括脑干等关键区域，最初避免使用驱虫药物。
这种罕见但可治疗的疾病的罕见表现使其在热带医学领域成为一个重要的报告观察。
